Provider Demographics
NPI:1679946115
Name:KM GROUP LLC
Entity Type:Organization
Organization Name:KM GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-956-0547
Mailing Address - Street 1:4390 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2735
Mailing Address - Country:US
Mailing Address - Phone:314-956-0547
Mailing Address - Fax:
Practice Address - Street 1:4390 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2735
Practice Address - Country:US
Practice Address - Phone:314-956-0547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015010117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty